The far-lateral craniotomy: tips and tricks (original) (raw)
British journal of neurosurgery, 2018
Fronto-Temporo-Orbito-Zygomatic (FTOZ) craniotomy has progressed from its humble beginnings. Numerous variations including one piece, two piece and even three piece FTOZ craniotomies have been described. The ideal technique still remains elusive and its use remains restricted to a few specialised centres even when benefits far outweigh the surgical difficulties. To analyse 11 cases in which single piece FTOZ craniotomy was used and to review the steps of surgery along with its advantages. A total of 11 cases of skull base lesions were operated over a period of 30 months and followed up for a minimum period of 6 months. They were analysed for intraoperative benefits, requirement of cerebral retraction, surgical difficulties, post op recovery, complications faced and post-op cosmetic appearance. A total of nine cases had tumours of skull base including Spheno-Petro-Clival meningiomas, Trigeminal schwannomas, Solitary fibrous histiocytoma and two had giant aneurysms of P1 segment. Intr...
En-bloc craniotomy for the pre-sigmoid infra- and supratentorial approach: technical note
Acta Neurochirurgica, 2011
The combined supra-infratentorial approach as described some 30 years ago is to date considered a standard procedure for skull base procedures. Several variants have been devised, including preservation of the mastoid process. We herein present the cosmetically most sophisticated and fastest solution. The authors describe an en bloc supra- and infratentorial pre-sigmoid combined approach. This variant of surgical technique involves a one-piece bone flap (temporal-suboccipital-mastoideal flap). We present another variant of craniotomy for the combined supra- and infratentorial pre-sigmoid approach that preserves the mastoid process and thus appears to be cosmetically much more acceptable. Eight dry cadaveric skulls were used to develop an ideal one-piece excision of the cranial vault across the transverse sinus, including portions of the mastoid. Our aim was that no further drilling of the basal skull was needed. The procedure thereafter was practiced on a fresh prepared cadaveric specimen where its feasibility was again confirmed and was then applied to a patient suffering from a huge petroclival meningioma. It was very well tolerated and produced an excellent long-term cosmetic result. The combined supra- and infratentorial pre-sigmoid approach offers the possibility of resecting complex petroclival lesions. The variant presented herein is less time consuming than previously described methods and probably offers the best possible cosmetic result. The en-bloc cranioplastic approach with preservation of the mastoid process is a new, interesting variant of a classical technique that is easy to perform and has the intention of achieving the best possible cosmetic result.
Neurosurgery, 2010
The arterial and venous systems of 6 cadaveric heads with no known brain pathology were injected with col-OBJECTIVE: The aim of this study was to describe quantitatively the properties of the posterolateral approaches and their combination. METHODS: Six silicone-injected cadaveric heads were dissected bilaterally. Quantitative data were generated with the Optotrak 3020 system (Northern Digital, Waterloo, Canada) and Surgiscope (Elekta Instruments, Inc., Atlanta, GA), including key anatomic points on the skull base and brainstem. All parameters were measured after the basic retrosigmoid craniectomy and then after combination with a basic far-lateral extension. The clinical results of 20 patients who underwent a combined retrosigmoid and far-lateral approach were reviewed.
The Transglabellar/Subcranial Approach to the Anterior Skull Base
Archives of Otolaryngology–Head & Neck Surgery, 2001
To describe the transglabellar/subcranial approach to the anterior skull base and to compare it with more traditional approaches to craniofacial resection. Design: A retrospective analysis of 72 cases at 2 academic medical centers. The main parameters analyzed were the disease entities treated, the average operating room time, the average amount of blood loss, the number of transfusions, the length of intensive care unit and hospital stays, and complication rates. These were compared with published data for traditional craniofacial approaches.
The “Agnes Fast” Craniotomy or the Modified Pterional (Osteoplastic) Craniotomy
Skull Base Surgery, 2011
The ''Agnes Fast'' craniotomy is a fast and simple way of performing the pterional craniotomy while preserving the temporalis muscle, together with its fascia and bony attachment. Using this technique, the surgeon need not divide the temporalis muscle, separate it from its bony attachment, or perform an interfacial dissection. With a little practice, this craniotomy can be performed in less than 5 minutes and is highly recommended in emergent settings. The modified pterional craniotomy was performed in 10 cadaveric specimens, preserving the temporalis muscle with its attachment. An interfascial dissection was not performed while exposing the frontozygomatic process. The exposure gained, the length of the procedure, and the ease of application were recorded for all heads studied. In all heads studied, the Agnes Fast craniotomy was performed, with complete preservation of the temporalis muscle and its attachments. This procedure was performed quickly, with complete preservation of the fascial nerve and its branches. The muscle was put back in its natural place following the craniotomy. The Agnes Fast craniotomy offers a fast way of performing a pterional craniotomy while preserving the temporalis muscle, with its blood supply, neural innervation, bony attachment, and fascia intact. Replacing the muscle is also fast and simple and involves placement of two CranioFix (Aesculap, Inc., Center Valley, PA) holders to the bone, with no suture material. This approach does not limit the exposure gained and offers the same exposure as the ''usual'' pterional craniotomy.
Minimally Invasive Craniotomy Using the Steiner-Lindquist Stereotaxic Guide
min - Minimally Invasive Neurosurgery, 2001
nnnn n n Thirty-three obscure intracranial lesions were located using the Steiner-Lindquist microsurgical stereotaxic guide and then surgically resected. Seventeen of the lesions were located in the parietal region, six in the frontal region, three in the parietooccipital region, three in the temporoparietal region, one in the thalamic region, one in the centrum semiovale, one in the brainstem, and one in the third ventricle. Twenty-three lesions were in subcortical or cortical locations. In 28 cases, the lesion was totally removed, while in 5 the lesion was subtotally resected. Pathological examinations confirmed glial tumor in eight patients, metastasis in seven, meningioma in two, cavernous angioma in eight, arteriovenous malformation (AVM) in four, hematoma in two, dysembryoblastic neuroepithelial tumor in one, and septum pellucidum cyst in one. Two patients developed transient complications postsurgery. Mean lesion size was 23 0.97 mm. The hospitalization period ranged from 1 to 6 days (mean 3.4 1.3 days). Surgeries were performed under general anesthesia, or under local anesthesia with the patient awake. The Steiner-Lindquist microsurgical stereotaxic guide is useful for pinpointing small lesions, especially those in the subcortical and deep areas. Knowing the precise location of the lesion facilitates removal through a small craniotomy incision. This minimally invasive procedure reduces the number of postoperative neurological complications, and also cuts costs by shortening the hospital stay.
Neurosurgery, 2006
Objective: During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact significantly on patient outcome. The primary aim of this study is to detail the strategies for complication management and avoidance developed from experience with 120 patients who underwent anterior and anterolateral cranial base procedures during the past 14 years. Methods: Between July 1990 and February 2004, 62 male and 58 female patients underwent 120 combined (neurological surgery and otolaryngology joint participation) anterior and anterolateral cranial base procedures. Fifty-four percent had malignant pathology, and 46% had benign pathology. The approaches taken were transfacial (10%), extended subfrontal (33%), lateral craniofacial (23%), and anterior craniofacial (35%). Thirty-day morbidity and mortality were analyzed. Results: Twenty (17%...
Prof medra paper,J Craniofacial Surgery,2012
In syndromic craniosynostosis, the relation between the supraorbital area and the frontal bone is not good, and it is not possible to reform this area with 1-block advancement. To avoid this problem, the frontal bone is separated from the fronto-orbital bandeau, each is reshaped and remodeled separately, and then both are reattached.
Craniofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach
Skull Base, 1999
Cran iofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach Craniofacial approaches have become the procedures of choice for most tumors, trauma, and congenital anomalies involving the anterior cranial fossa and the orbits, nasal cavity, or paranasal sinuses. However, recent reports continue to document a complication rate of 39-50% and a mortality of 3-5% with these procedures,I prompting some authors to state that they are too morbid for routine use.2 We have used a modified subcranial approach for a variety of lesions at the anterior cranial base and have achieved a lower complication rate than previously reported. We report our technique and results in 31 consecutive cases. MATERIALS AND METHODS This series consists of 31 consecutive patients operated upon over a 4-year period by the authors. Patients were evaluated in a multidisciplinary clinic staffed by a team representing the neurosurgery, otorhinolaryngology, and neuro-otology disciplines. Patients were considered appropriate for a subcranial approach when they had tumors, trauma, or congenital anomalies for which surgery was indicated and that anatomically involved the face, orbit(s), nasal cavity, and/or paranasal sinuses 95